"Phew, I tell you what, I can't move for pharmacies these days. They're everywhere I turn, and I can't walk down a street these days without tripping over multiple green crosses. Everywhere you go its pharmacy here, pharmacy there, pharmacies everywhere"- No-one, ever.
And yet, apparently there are too many of the blighters, according to some pharmacy leaders. About 3,000 too many, give or take. Funnily enough, I beg to differ. And here's why.
I have worked in two newly-opened pharmacies in my career. In each, I was inundated with customers wandering in and telling me how lucky they were to have a pharmacy in their area. In one, the residents of the local area had campaigned for years to get their own pharmacy. Within months, the pharmacy was busy and the delivery service was thriving- and this was in a very small pit village.
We weren't, however, busy enough to justify a second pharmacist. This meant that I-despite good, efficient staff- would have to work many a late night-for no extra pay or lieu time- just to keep my head above water. The pharmacy closed at 5.30pm. I was regularly there until 10.30pm on a Thursday night, dispensing and checking prescriptions to make sure we were clear for Friday morning so that we could get all the prescriptions done and delivered in time for the weekend. This was just to keep on top of the day to day dispensing and didn't take into account any of the routine business things I had to do, like writing SOPs, Business continuity plans, finances, etc etc etc as a pharmacy manager. The pharmacy opened at 9am. I would turn up at 7:30am (again, unpaid) to get the till float done, prescriptions counted etc before we opened.
Its not that my time management or organisation was bad. It was just the sheer volume of work that needed to be done. I got away lightly- one of my fellow pharmacists in a different branch was known to be still at work at 2am at least once a week, just to keep afloat.
This was a few years ago now, but I locum fairly regularly and I still see busy pharmacies, with staff working flat out to get their work done as efficiently as possible. Not that much seems to have changed. What I don't see is empty, quiet overstaffed pharmacies filled with bored staff who have nothing to do.
One day, the managing director for the company came round, and had a go at me because I hadn't been doing enough Medicines Use Reviews (MURs). Now, I was initially enthusiastic and excited about MURs. I couldn't wait to sit down with patients and get my teeth into providing a good quality service.
But I just couldn't do it. I didn't have time to do as much training, preparation, and CPD as I wanted to, and as a result I was nervous of doing MURs. What didn't help was the fact that, throughout each one, a large part of my brain was taken up with worries about how many prescriptions were piling up in the dispensary, when I wanted to give the patient my full attention. Each 15-20 min slot I spent in the consultation room with a patient meant I was behind with prescriptions- and because most of mine were deliveries, this had a huge knock on effect on the delivery drivers, and ultimately, the patients, who would then ring up in a panic wondering why their medicines hadn't been delivered by the usual time, putting us even further behind schedule. Thus began a vicious circle, worsened by my own constant feeling that I was so thinly stretched I just wasn't able to do enough justice to every aspect of my work. I'm by no means a perfectionist, but I like to do things well, and the fact that I just didn't have the resources to do so constantly played on my mind.
I ended up frustrated at my own inadequacies and inability to get on top of the situation, stressed to breaking point, and incredibly disheartened. I'd even go so far as to admit that resentment started creeping in too. I know I'm not alone here, and suspect that the majority of community pharmacists have felt this way.
MURs are just one example of a service of course. In the year and a bit I worked at that pharmacy, we started doing MURs, morning after pill, over 50 men's health checks, diabetes screening, a minor ailments scheme, smoking cessation schemes, and a weight management scheme, amongst others. I was desperately swimming against a tidal wave of more and more jobs to do in the same amount of time.
Each time I read a pharmacy magazine like Chemist + Druggist, there seems to be yet another call from yet another pharmacy body or the other for pharmacists to be involved in delivery of yet another service. And my heart sinks, because I wonder just how on earth this is supposed to fit in with all of the other jobs that need doing.
Now, I'll admit that I haven't read the Now or Never report from the Royal Pharmaceutical Society commission (on account of being a cash-strapped non-member pleb). Nor have I kept up to date with the response to it on social media, blogs etc (on account of a fairly severe bout of anxiety-induced apathy over the last few days). With that in mind, though it still seems to me that the following metaphorical conversation is going on:
Pharmacy leaders: "And, and, and, you would be really good at delivering all these new services, so you should start doing that."
Pharmacist (from underneath a large pile of prescriptions that need checking, in between phone calls, and being called to the counter to speak to patients): "Yeah, I probably would be good at that. And I would love to do it, if only I had time."
Pharmacy leaders: "Good, well that's settled then. We'll pay you less for dispensing, but because you'll be doing all these services that will definitely be okay because you'll make up the money elsewhere."
Pharmacist (desperately attempting to gulp from a cold cup of tea to avoid dehydration): "Erm, right. Sorry, I need to go and talk to a patient now hold on... right, sorry, I'm back, what were you saying again? oh hang on, that's the phone ringing, I'll just have to get that..."
Pharmacy leaders: "We're so pleased you're co-operating. Oh, and by the way, we've decided there's too many pharmacies, so we're going to close all the ones near you, so you'll be getting more prescriptions to do, and more customers."
Pharmacist: "hang on, whaa- yes Mrs Brown, your prescription will only be a couple more minutes"
Pharmacy leaders: "Great! so to summarise, that's more prescriptions, more customers, more services, less pay. See you later!" (flounces off)
Pharmacist: "What in the hell just happened?... No no, Mr Smith, its okay, I don't need to see your haemorrhoids again, thank you"
Strategic decisions and the bigger picture are all very well, but at the end of the day they are just words if the people at the front line aren't able to deliver the vision because they are already overloaded. To me, it feels like new ideas, new visions and new services are bandied about by the top level folk, but what they neglect to do is look at the minutiae and check how the "little people", the folk on the ground are doing and what they think about any changes.
The realities of life on the shop floor are, in my mind, not conducive to delivering the sorts of services that the profession is calling for, unless there is a huge overhaul in how pharmacies are staffed, funded, and managed. And given that, in these austere and pressured times, everything possible is being done to reduce costs, pare down staffing, and maximise profits, I just cannot see the sort of situation in which we can do all of these things to the best of our abilities well panning out in real life. Yes, great changes in the direction of the profession need to come from the top, but they also need to come from the pharmacists behind the counter in the little pharmacy in the tiny pit village too.
The only way that I would have been able to deliver MURs in my pharmacy to the standard and quality that I so desperately wanted to acheive would have been to have had a second pharmacist present. And the only way a second pharmacist would have been present was if they had been paid. And the only way the company would have paid for a second pharmacist would have been if they were absolutely, just short of gunpoint, forced to.
I'd like to suggest that before the profession starts excitedly waving its hands and shouting "ME ME ME!!" to every available service going, we take a step back and decide whether or not we can actually deliver it, given everything else we also have to do. That enthusiasm is great, but if we can't follow it up with actions, we will end up an all-talk and no substance sort of profession.
So, in summary: are there too many pharmacies? No, although there might be the odd street or village which has more than its fair share. To be honest its a moot point. What's a more important question is: "what can we do to support pharmacists and improve the quality of services in the pharmacies we've got?"
Hxx
